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Physicians Screen and Turn Away Patients To Avoid Lawsuits

Nurses Article   (4,385 Views | 23 Replies | 806 Words)

J.Adderton has 27 years experience as a BSN, MSN .

7 Followers; 123 Articles; 34,678 Profile Views; 396 Posts

Is it Ethical to Turn Patients Away Because Red Flags Signal Risk for Suit?

Some physicians, in office-based practices, are protecting themselves by turning away patients identified as having a potential to sue.  Read on to learn more about this practice and potential pitfalls.

Physicians Screen and Turn Away Patients To Avoid Lawsuits
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According to the AMA’s Division of Economic and Health Policy Research, more than 34% of physicians have had a liability lawsuit filed against them at some point in their careers. Although plaintiffs in the majority of cases don’t win, the average cost for defending a case is more than $30,000 A recent article published on Medscape looked at how physicians are attempting to protect themselves by screening out patients who are more likely to file suits.

Not Obligated to Treat Anyone

As consumers, we are usually able to pick what physician we see and can change providers if we are not satisfied. What about physicians- are they obligated to treat anyone seeking their services, or do they have a right to self-select patients? According to the American Medical Association’s Economics and the Ethics of Medicine, an office-based physician doesn’t have to treat every patient seeking care.

Quote

“Physicians are not ethically required to accept all prospective patients…...physicians should be thoughtful in exercising their right to choose whom to serve.”

Economics and the Ethics of Medicine, AMA 1936

Possible Red Flags

Medscape’s article highlights Dr. Marie Bradshaw, a physician practicing internal and emergency medicine over the course of 27 years. What makes Dr. Bradshaw unique? In her long career, she has never been sued as a physician. Dr. Bradshaw interviews potential patients before agreeing to be their primary care doctor and credits this practice for preventing legal problems. Here are other factors Dr. Bradshaw considers before accepting a new patient:

How many physicians in that specialty has the patient seen over the past 1-2 years?

  • More than 2 could be a sign of “doctor shopping”
  • Important to ask if they terminated the relationship or did the doctor….and why.

Did the patient have problems with other doctors or practices.?

  • Asking the patient if they have ever had “an issue” with another doctor may open the door to learning about a previous lawsuit.

What is the patient’s attitude toward the practice’s conditions for treatment?

  • Does the patient complain about or refuse to sign an agreement related to treatment?
  • This could be a red flag the patient will become difficult later in the relationship

Compliance with clinical recommendations.

  • Is the patient compliant with health screenings (mammograms, colonoscopies, etc.) and treatment recommendations?

Is the patient show consideration for the practice and staff?

  • Impolite behavior and rudeness towards others are a big red flag.
  • Potential for violence should be a deal breaker.

Do you communicate well with the patient and have a good rapport?

  • It may be a red flag if intuition is telling you it may be difficult to build a good rapport with the patient.

Joseph Scherger, MD, former vice president of primary care and academic affairs at Eisenhower Medical Center, recommends getting the above information while taking the patient’s medical history.

Nurses Have Valuable Insight

Michael Sacopulos, JD, CEO of the Medical Risk Institute, has sat in on hundreds of malpractice lawsuits over the years and emphasizes the need to pay attention to how a patient treats office staff. He states “I can't tell you how many times I've heard physicians say that when the paperwork arrives, the staff isn't surprised".

Patients are more likely to voice concerns or dissatisfaction to nurses and other staff members. Dr. Sacopulos theorizes that staff members are cued in on warning signs quicker because patients tend to be on their best behavior for the doctor. Therefore, it is important for physicians to listen and consider feedback from staff.

There Are Risks

When it comes to turning away or discharging patients, there are state and federal laws physicians must follow. Noncompliance with these laws may lead to complaints being made to state or federal agencies, resulting in an investigation by the state attorney general’s office. A patient, who was not accepted, could file a complaint with the medical board that they were not treated properly. In this case, the physician would need to demonstrate that a physician-patient relationship never existed. For example, a written letter notifying the patient of nonacceptance may be used as evidence the patient was not under the physician’s care.

Taking It to the Extreme

What do you think? Does the practice of screening for potentially litigious patients encourage an attitude of “patients are out to sue you”? What ethical pitfalls do you see?

J. Adderton MSN has over 20 years experience in clinical leadership, staff development, project management and nursing education.

7 Followers; 123 Articles; 34,678 Profile Views; 396 Posts

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Daisy4RN has 20 years experience and specializes in Travel, Home Health, Med-Surg.

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I dont see any problem with MDs or other healthcare staff not accepting patients especially when I have seen first hand for over 20 yrs how the general population treats staff and it has only been getting worse, IMO. I have also seen MDs in the hospital not accept and/or fire patients. People these days expect a perfect outcome and complain and sue when they dont get it.

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TriciaJ has 39 years experience as a RN and specializes in Psych, Corrections, Med-Surg, Ambulatory.

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A physician-patient relationship should function as a contract. Why should anyone expect a contract to be completely one-sided?

During my career I've seen many people burn through an abundance of resources but demonstrate extreme unwillingness to lift a finger on their own behalf. Physicians absolutely should be allowed to require accountability from their patients.

The customer service model does not work in healthcare. The squeaky wheels frequently rob resources from the severely ill. Lawsuits grossly drive up the cost of healthcare for everyone.

I'm all for physicians having a say in the matter.

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322 Posts; 71,839 Profile Views

Start video at 08:40 (watch to 10:11):

It applies to nurses, too.

Edited by DTWriter

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I don't think the best way to begin a relationship that for the patient is based on trust between them and the physician, is to vet the patient/prospective patient for possible signs/characteristics that they may be a risk to the physician's financial or professional livelihood. When one starts out looking for the worst in another person one tends to find it.

Employing methodology to assist the physician in determining whether the patient will be a "good patient who will not be a financial/professional risk to the physician's practice regardless of the patient's particular situation, individual circumstances, or personal experiences," with the intention of gleaning psychological information about the patient, is not ethical in my opinion.

As far as a patient suing a physician, for malpractice claims in my state there is a specific, very short time window of not more than a few years if I recall correctly in which a claim can be brought. Considering that it may not even be possible to determine the full extent of a patient's injuries within that time, and considering that patients that are harmed, including their family members, may be expending all their resources - emotional, and financial - on trying to assist the patient to recover, and have no time, energy, or money to spend on initiating a lawsuit, the legal system in regard to bringing suit against a physician favors the physician not the patient.

Of course there should be regulations as to the circumstances under which physicians can discharge patients. Physicians have a legal duty of care to their patients.

With electronic health records today, large amounts of patient data exist, and there is the ever present potential for patient data to be used in ways the patient never consented to nor would choose to consent to.

Edited by Susie2310

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I don’t see any “ethical” pitfall to avoiding contact with those who are inherently poisonous - even if they aren’t litigious, there are many people who are abrasive, obnoxious and rude. Coincidentally, experience shows that the same people accept no responsibility for their own actions. Life is far too short to voluntarily and knowingly accept people who have a history of causing problems.

the “customer service model” is widely adopted by executives who wouldn’t accept for one minute the behavior and attitudes they expect the front line staff to turn the other cheek to.

I mean, really - how many times has a patient who *doesn’t have a job* tried to tell you what (they think) your job is (often related to waitressing, btw).

Edited by rzyzzy

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1 hour ago, rzyzzy said:

I don’t see any “ethical” pitfall to avoiding contact with those who are inherently poisonous - even if they aren’t litigious, there are many people who are abrasive, obnoxious and rude. Coincidentally, experience shows that the same people accept no responsibility for their own actions. Life is far too short to voluntarily and knowingly accept people who have a history of causing problems.

The determination of abrasiveness, obnoxiousness, and rudeness, and their measurement, is subjective to a degree, that is, dependent to a degree on the experience and values of the person experiencing the so-called offensive patient behaviors. Additionally, health care providers themselves quite often display these characteristics. Health care providers sometimes have very poor ability to relate to patients empathetically, with consideration, and in this case must take responsibility for provoking some of the patient behaviors that they are offended by.

The Patient's Bill of Rights that large medical practices post in a visible place that can be seen by members of the public, setting forth patients rights and responsibilities, is a reasonable way to communicate expectations. The majority of patients are reasonable in their expectations of health care providers and behave reasonably given the frequent stressors that are experienced in the process of receiving care.

Edited by Susie2310

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Daisy4RN has 20 years experience and specializes in Travel, Home Health, Med-Surg.

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25 minutes ago, Susie2310 said:

. The majority of patients are reasonable in their expectations of health care providers and behave reasonably given the frequent stressors that are experienced in the process of receiving care.

If this is true then there won't be any problems/issues with MDs doing this.

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Quote

"...have no time, energy, or money to spend on initiating a lawsuit, the legal system in regard to bringing suit against a physician favors the physician not the patient."

I believe most malpractice lawsuits are taken on the contingency that if they win the attorney gets paid. If not, he/she doesn't.

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OUxPhys has 4 years experience as a BSN, RN and specializes in Cardiology.

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Absolutely. I've seen first hand how patients and family members treat staff, write down everything you do when you walk into the room. There were even times when they tried taking our picture without our consent.

This is one of the problem with our medical model. It's so easy to sue for anything and everything which in turn drives up the malpractice insurance rates so high.

In countries that have single payer/universal healthcare it is much harder to sue.

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19 minutes ago, OUxPhys said:

Absolutely. I've seen first hand how patients and family members treat staff, write down everything you do when you walk into the room. There were even times when they tried taking our picture without our consent.

This is one of the problem with our medical model. It's so easy to sue for anything and everything which in turn drives up the malpractice insurance rates so high.

In countries that have single payer/universal healthcare it is much harder to sue.

Have you considered that it's not about the nurse/physician/health care facility and that patients and their family members very often take notes because they are trying to keep track of the care the patient is receiving and are trying to do their best to advocate for the patient? They will be talking with the physician about the patient's condition and treatment and the notes are a memory aid for them. Even thought I am familiar with health care settings I take notes for this purpose when my family members are hospitalized. I very much doubt that people take notes with the primary intention of suing the nurse/physician/facility; usually they just want the patient to receive the right treatment in a timely way and to recover to the point that they can be safely discharged. Also, many family members will have Healthcare Power of Attorney and/or another type of POA and they have the legal responsibility of making decisions for the patient according to the patient's POA if the POA is invoked.

Nursing liability/malpractice insurance is generally very inexpensive. Of course physicians are going to pay more for malpractice insurance.

Do you think the nurse/physician shouldn't have a duty of care towards the patient? That if they breach the Standard of Care and patient injury results due to this breach that the patient and their family should just live with the consequences and have no ability to seek justice or compensation? I understand many of us would like to have a world where actions have no consequences. Medical errors have been shown to be one of the leading causes of death in the US, and to my knowledge medical errors that result in a patient's death are not listed on a patient's death certificate. It seems that you would like patients and their family members to have fewer rights - you stated that with single payer/universal health care it is harder to sue - this gives me a clue as to why some people including some health care professionals are in favor of this type of health care and it is not just because everyone will have access to care.

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OUxPhys has 4 years experience as a BSN, RN and specializes in Cardiology.

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1 hour ago, Susie2310 said:

Have you considered that it's not about the nurse/physician/health care facility and that patients and their family members very often take notes because they are trying to keep track of the care the patient is receiving and are trying to do their best to advocate for the patient? They will be talking with the physician about the patient's condition and treatment and the notes are a memory aid for them. Even thought I am familiar with health care settings I take notes for this purpose when my family members are hospitalized. I very much doubt that people take notes with the primary intention of suing the nurse/physician/facility; usually they just want the patient to receive the right treatment in a timely way and to recover to the point that they can be safely discharged. Also, many family members will have Healthcare Power of Attorney and/or another type of POA and they have the legal responsibility of making decisions for the patient according to the patient's POA if the POA is invoked.

Nursing liability/malpractice insurance is generally very inexpensive. Of course physicians are going to pay more for malpractice insurance.

Do you think the nurse/physician shouldn't have a duty of care towards the patient? That if they breach the Standard of Care and patient injury results due to this breach that the patient and their family should just live with the consequences and have no ability to seek justice or compensation? I understand many of us would like to have a world where actions have no consequences. Medical errors have been shown to be one of the leading causes of death in the US, and to my knowledge medical errors that result in a patient's death are not listed on a patient's death certificate. It seems that you would like patients and their family members to have fewer rights - you stated that with single payer/universal health care it is harder to sue - this gives me a clue as to why some people including some health care professionals are in favor of this type of health care and it is not just because everyone will have access to care.

Sure did. I apologize if I insinuated that all note takers are looking to sue. That was not my intent, but, when you have family members complain about anything and everything I highly doubt it is to chart the progress of their care.

Of course nursing malpractice insurance is cheap, so cheap that hospitals usually cover it for their nurses. I was referring to MD malpractice. The fact it is so high just shows you where we are as a society.

Absolutely. Nurses and doctors should be held to a high standard of care. I never said patients dont have the right to sue. If there is clear negligence that resulted in harm or death then they have every right and the provider should be held accountable.

This is the sad fact: in our society there are people looking to make a quick buck by suing for malpractice even when there is no harm or wrong by the hospital/provider. Just look at all the lawyer advertisements.

No, I'm more for universal care because it will make healthcare more affordable in the long term. The military currently has a law where you are not allowed to sue if a physician makes a mistake, which I am 100% against and hope they pass the law they introduced intended to repeal it.

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